Selective surgical containment for Legg-Perthes disease: recognition and management of complications

Surgical containment is often selected for older children with "at risk" Legg-Perthes disease because healing time is long and abduction bracing is poorly tolerated. This review of 19 older children (mean age, 9.6 years) treated by surgical containment, selected from a total of 167 patients with Legg-Perthes disease, demonstrates the frequency of complications when only older children with severe involvement are surgically contained. The radiographic results (37% good, 26% fair, 37% poor) are mediocre when compared with reported series in which patients were not selected critically for "at risk" factors or in which the means age was lower. Although surgically contained, the femoral head in certain older children with "at risk" Legg-Perthes disease is unable to tolerate full activity. The avascular head responds in much the same manner as the adult femoral head with avascular necrosis (slow repair, marked collapse): therefore, older children treated surgically must be followed closely. Failure of containment, with head collapse, following surgical containment is heralded by a loss of hip motion and must be treated vigorously by reinstituting the usual nonsurgical protocol (hospitalization, traction, muscle release, arthrogram. Petrie casts, abduction bracing). Obviously, prior to surgical containment, the family should be advised of the possible later need for rehospitalization and a return to abduction casts or braces.